Graham A. Colditz, MD, DrPH and coauthors K. Y. Wolin and Sarah J. Gehlert of the Siteman Cancer Center at Washington University in St Louis conclude that we now have the knowledge to bring about wide scale prevention of a disease estimated to kill 577,190 men and women this year in the United States alone. "We actually have an enormous amount of data about the causes and preventability of cancer," stated Dr Colditz, who is the Siteman Cancer Center's associate director of prevention and control. "It's time we made an investment in implementing what we know."

Dr Colditz and colleagues observe that lifestyle choices play a major role in the development of cancer. Smoking is responsible for a third of all U.S. cancer diagnoses and excess body weight for 20 percent. Diet, exercise levels, alcohol intake and other controllable factors are also involved.

Obstacles outlined in the article include continued widespread skepticism that cancer can be prevented, short term focus of cancer research due to the challenge of long term studies and limited research funding; interventions that are administered too late to prevent the disease, debate concerning the causes of cancer that can overshadow what we do know about risk factors, societal factors such as tobacco policy and government subsidies that fail to discourage unhealthy behavior, lack of interdisciplinary collaboration, and challenges in the implementation of broad changes involving healthcare providers, government regulators and individual members of society.

Despite the challenges described in the article, the authors note that some rapid successes have taken place, such as the elimination of trans fatty acids from many foods and a reduction in lung cancer associated with stricter tobacco control. If our society succeeds in adopting all that is currently known about cancer prevention, these measures will additionally reduce deaths from cardiovascular and other diseases.

"After working in public health for 25 years, I've learned that if we want to change health, we need to change policy," remarked Dr Gehler, who is the E. Desmond Lee Professor of Racial and Ethnic Diversity at the Brown School of Social Work and the School of Medicine. "Stricter tobacco policy is a good example. But we can't make policy change on our own. We can tell the story, but it requires a critical mass of people to talk more forcefully about the need for change."

Researchers at the Centers for Disease Control and Prevention and Atlanta analyzed data from the National Health and Nutrition Examination Survey (NHANES) of 1988-1994, 1999-2004 and 2005-2010 for their research, which included a total of 44,959 participants. Survey responses and physical examinations provided information on the following cardiovascular health metrics: smoking status, physical activity level, body mass index, healthy diet intake, total serum cholesterol, blood pressure and fasting blood glucose. Mortality data obtained through 2006 ascertained 2,673 deaths, including 1,085 deaths from cardiovascular disease and 576 ischemic heart disease deaths over a median follow-up period of 14.5 years.

Subjects were scored on optimal status for each of the seven health metrics, i.e., not smoking, being physically active and having healthy body mass index, diet, serum cholesterol, blood pressure and hemoglobin A1C (indicating desirable glucose levels). Less than 2 percent of all participants met all seven goals. Having two or more optimal factors was associated with a 27 percent lower adjusted risk of dying of cardiovascular disease compared to one or no factors, and this risk continued to decline in association with an increasing number of factors to reach a 76 percent reduction with the presence of six or more factors. Additionally, having six or more factors was associated with a 51 percent lower risk of dying of any cause.

"Our findings indicate that the presence of a greater number of cardiovascular health metrics was associated with a graded and significantly lower risk of total and cardiovascular disease mortality," the authors conclude.

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